Efficacy of Mechanical Circulatory Support Used Before Versus After Primary Percutaneous Coronary Intervention in Patients with Cardiogenic Shock From ST-Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis |
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| Affiliation: | 1. Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA;2. Center for Research in Indigenous Health, Wuqu'' Kawoq|Maya Health Alliance, 2a Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpán, Chimaltenango, Guatemala;3. Division of Cardiology, Texas Tech University Health Sciences Center, Lubbock, TX, USA;1. Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew''s Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, United Kingdom;2. Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, United Kingdom;1. Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany;2. Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany;3. Department of Cardiology, Odense University Hospital, Odense, Denmark;4. Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele University, Milan, Italy;5. Department of CardioThoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy;6. Technische Universität Dresden, Campus Chemnitz, Klinikum Chemnitz gGmbH, Chemnitz, Germany;7. Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France;8. Farmington, NM, United States;9. Banner University Medicine Cardiology Clinic, Phoenix, AZ, United States;10. Wellstar, GA, United States;11. Ascension, Warren, MI, United States;12. University Cardiology Associates, Augusta, GA, United States;13. Division of Cardiology, Abiomed Inc., Danvers, MA, United States;14. Department of Cardiovascular Medicine, Northside Cardiovascular Institute, Atlanta, GA, United States;15. Cardiovascular Research Foundation, New York, NY, United States;p. Columbia University Medical Center, New York, NY, United States;q. Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, United States;r. Henry Ford Medical Center, Department of Interventional Cardiology and Structural Heart, Detroit, MI, United States;s. The Cardiovascular Center, Tufts Medical Center, Boston, MA, United States;t. St Francis Heart Center, Roslyn, New York, NY, United States;1. Division of Cardiology, Cardiovascular Medical Center, Far-Eastern Memorial Hospital, New Taipei City, Taiwan;2. Division of Cardiovascular Surgery, Cardiovascular Medical Center, Far-Eastern Memorial Hospital, New Taipei City, Taiwan;3. National Yang-Ming University School of Medicine, Taipei, Taiwan |
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| Abstract: | BackgroundOptimal timing to initiate mechanical circulatory support (MCS) in patients with ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS) remains unclear with studies showing conflicting results on whether to start before or after primary percutaneous coronary intervention (PPCI). This study aims to examine the association between mortality and MCS initiated before vs after PPCI in patients with STEMI complicated by CS.MethodsWe systematically searched PubMed, Embase, and Scopus for abstracts and full-text articles from inception to October 2021. Studies were included if they evaluated the association of mortality in patients who initiated MCS (specifically intra-aortic balloon pump (IABP), Impella, and venoarterial extracorporeal membrane oxygenation (VA-ECMO)) before PPCI versus after PPCI, specifically in patients with STEMI complicated by CS. Data were integrated using the random-effects models.ResultsTen studies involving 1,352 patients (956, 203, and 193 patients underwent IABP, Impella, and VA-ECMO respectively) with STEMI complicated by CS were included. There was no difference in mortality using IABP before or after PPCI ([OR] 1.77, 95% CI 0.77–1.61, I2 = 27%, p = 0.57). Nevertheless, Impella and VA-ECMO started before PPCI were significantly associated with a reduced risk of mortality compared to that started after PPCI ([OR] 0.49, 95% CI 0.26–0.92, I2 = 0%, p = 0.03 and [OR] 0.29, 95% CI 0.14–0.62, I2 = 0%, p = 0.001, respectively).ConclusionsIn patients with STEMI complicated by CS undergoing PPCI, the use of IMPELLA or VA-ECMO prior to PPCI significantly decreased mortality, in contrast to IABP, in which no difference in mortality was found between using it before or after PPCI. More rigorous studies are needed to clarify this association. |
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